Original articleCharacteristics of Alzheimer's disease patients with a rapid weight loss during a six-year follow-up
Introduction
In patients with Alzheimer's disease (AD), weight loss contributes to the alteration of general health, to the frequency and severity of complications, especially infectious, and to a faster loss of independence. It occurs in about 40% of AD cases, including very early stages, before diagnosis is even possible.1
We have previously reported two different modes of weight loss in AD after a one-year follow-up2: a gradual weight loss (4% or more, known as an independent factor of morbidity and mortality in the elderly3), present in one third of the cohort, whose major risk factor was disease severity (assessed by the Reisberg score). Another mode of weight loss, observed in 10% of patients, was rapid (≥5 kg in the first six months); risk factors for this rapid weight loss were an intercurrent event such as an acute disease, hospitalization or a change of living arrangements.
Characterizing weight loss in AD patients may be crucial: indeed, the progressive and irremediable weight loss featured in late-phase dementia is considered a contra-indication to nutritional support, whereas an acute weight loss may benefit from an aggressive nutritional support.4 Also, an early intervention strategy could be implemented in the latter, in order to prevent or at least decrease the loss.5
The main purpose of this study was to characterize this population of AD patients showing a rapid weight loss (defined as the loss of at least 5 kg in 6 months) during a 6.5-year follow-up.
Section snippets
Study design
This was a single-center, prospective cohort study in the hospitals of Toulouse, France, as part of the Etude Longitudinale de Suivi de la Maladie d'Alzheimer (ELSA study), which has followed ambulatory patients with dementia of Alzheimer type since 1994.
Follow-up comprised a 6-monthly evaluation in the daycare hospital and the collection of intercurrent events by telephone from the general practitioners and/or caregivers every three months during 6.5 years after enrollment.
The diagnosis of AD
Population characteristics at inclusion
395 patients were included. These 395 subjects were followed-up for up to 6.5 years with a mean follow-up of 2.5 years. During follow-up, 65 subjects left the study at the request of their family and 86 died (Fig. 1). The characteristics of the population at inclusion in the ELSA study are mentioned in Table 1, and the flow chart of the cohort appears elsewhere.2
Descriptive analysis of the intercurrent events preceding rapid weight loss
137 events were collected in the 6 months before every weight loss higher than 5 kg (Table 2). This event concerned 27.8% of subjects (n
Discussion
In a previous article about the same cohort,2 we described a rapid weight loss over the course of AD; risk factors for this rapid weight loss were an intercurrent event such as an acute disease, hospitalization or a change of living arrangements. Such risk factors were also found over the whole course of the study; these are not surprising, as they are commonly associated with anorexia in the elderly. The prognostic factors on inclusion were less expected: a higher PINI at inclusion was an
Conflict of interest
None declared.
Acknowledgements
This study was supported by a grant from the French Ministry of Health (Programme Hospitalier de Recherche Clinique).
We gratefully acknowledge Mélanie Koning for assistance with the analysis, and Patrice Brocker for their review of the manuscript and much other advice.
SA and BV were responsible for the study concept and design. OG, SA, CC and BV were responsible for the analysis and interpretation of the data. OG, SA, SMS and BV drafted the manuscript. All authors were responsible for the
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